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Proposed Mechanisms Preventing GABA receptor downregulation Counteracting compensatory NMDA glutamate receptor sensitization Stabilizing benzodiazepine receptor configuration (preventing shift to inverse agonist state) Upregulating GABAergic neurotransmission through pathways distinct from benzodiazepine action itself This tolerance prevention has profound clinical implications

The initial dosing chart gets you started, but the real complexity emerges when you are months into treatment and need to optimize rather than just escalate